July 3, 2026
Dear Interested Readers,
Reflecting What We Can Learn About Healthcare Today From the Fourth of July
I probably don’t need to tell you that tomorrow is our nation’s 250th birthday. I expect that for many readers of these notes, the 200th anniversary seems just like yesterday. In 1976, I was a year into my career practicing internal medicine and cardiology at Harvard Community Health Plan. We lived in a very friendly neighborhood in Newton, Massachusetts. Our neighbors on one side were a radiology fellow from Australia doing a two-year fellowship at the Brigham, his wife, and two sons. The neighbors on the other side were a professor from Ohio who taught at Boston College’s business school, his wife, and two sons. My house was on the corner, so our backyards connected, and in the summertime, we did a fair amount of socializing.
The fourth of July in 1976 was on a Sunday, which meant it was a three-day holiday weekend. I don’t remember who had the bright idea, but the decision was made to have a collective three-day celebration of the Fourth, which would begin with the roasting of a suckling pig in my backyard. I think it was the professor who procured the pig while my Australian friend and I dug the pit behind my garage and started the fire. I didn’t know what I was doing, but someone must have had some experience. Again, I think it was the professor who was in his forties while the Australian and I were in our early thirties.
It was an all-day affair, and by late in the evening, when the pig was ready to eat, neighbors had gathered from up and down the street out of curiosity, and a block party had broken out. The celebration continued into the Monday holiday. Food and drink arrived from all over the neighborhood. It was an event that only gets better in memory.
My two older sons were at the event and will be here in New Hampshire with me tomorrow, along with two younger sons, spouses, five grandchildren, and a couple of my granddaughter’s friends for another huge celebration of the 250th at the home of our neighbor across the road. I plan to ask the two older guys what they remember of that happy weekend fifty years ago. They were eleven and almost six at the time.
The big national event that I remember from the summer of ’76 was the visit of the Tall Ships. The ships were in New York for the Fourth, but came to Boston about a week later, and we went down to the waterfront to see them. Gerald Ford, a genuinely nice guy, was trying to be everybody’s president after the ordeal of Nixon. I don’t remember anything he said or did, but what I’ve read suggests he tried to preside over a nonpartisan celebration, which doesn’t appear to be in the works this year.
As I did in 1976, I plan to focus locally for the Fourth since what I hear has been planned for Washington is hardly non-partisan, and it is no longer certain that our leader believes that self-evident truths apply to everyone and include the rights of “life, liberty, and the pursuit of happiness.”
I hope you have made special plans for your holiday celebration. I am sure that a few readers of this letter will be around for the celebration of our 300th in 2076, and I hope that your memories of ’26 will be as positive as my memories of ’76.
I enjoy history, and one of my first memorable accomplishments was winning the DAR medal for the best 8th-grade student in American History at West Junior High School in Waco, Texas, in 1959. As I was thinking about the Declaration of Independence this week, I remembered that the signers, all of whom would probably have been executed had the British won the Revolutionary War, included at least a couple of physicians. I decided to ask ChatGPT if I was correct. I liked the depth of the answer I got when I asked:
Will you give me the names of any physicians who signed the Declaration of Independence?
ChatGPT answered:
Yes. Although lawyers, merchants, and planters dominated the signers of the Declaration of Independence, four signers had medical training or practiced medicine. Their careers illustrate the close relationship between medicine, public service, and political leadership in colonial America.
1. Benjamin Rush (Pennsylvania)
Perhaps the most famous physician among the Founders, Benjamin Rush was one of the leading doctors in colonial America.
Contributions to medicine
- Professor of chemistry and later medicine.
- Founder of what became Dickinson College.
- Helped establish the Pennsylvania Hospital with Benjamin Franklin.
- Often called the “Father of American Psychiatry” for advocating more humane treatment of people with mental illness.
Political role
- Signed the Declaration of Independence in 1776.
- Served as Surgeon General of the Continental Army’s Middle Department.
- Advocated public education, abolition of slavery, and improved public health.
Medical legacy
Rush believed physicians had obligations not only to individual patients but also to society—a philosophy that strongly influenced later American public health.
2. Josiah Bartlett (New Hampshire)
Bartlett practiced medicine in Kingston, New Hampshire, before becoming active in politics.
Contributions to medicine
- One of New Hampshire’s leading colonial physicians.
- Successfully treated outbreaks of infectious disease.
- Early advocate of using Peruvian bark (containing quinine) for treating fevers.
Political role
- First New Hampshire delegate to sign the Declaration.
- Later became Chief Justice and eventually Governor of New Hampshire.
Connection to your interests
Bartlett remains one of New Hampshire’s most distinguished physician-statesmen, and his legacy continues to resonate in the state’s medical community.
3. Lyman Hall (Georgia)
Hall was educated in medicine in Connecticut before moving to Georgia.
Contributions
- Practiced medicine for many years.
- Became a strong supporter of independence despite significant personal risk.
Political role
- Signed the Declaration representing Georgia.
- Later served as Governor of Georgia.
Legacy
Hall strongly promoted education after the Revolution, helping lay the groundwork for what became the University of Georgia.
4. Matthew Thornton (New Hampshire)
Born in Ireland, Thornton immigrated to New Hampshire as a child.
Medical career
- Practiced medicine in Londonderry and surrounding communities.
- Served as a surgeon treating colonial militia during conflicts before the Revolution.
Political role
- Signed the Declaration several months after July 4, 1776, after being elected to the Continental Congress.
- Later served as Speaker of the New Hampshire House.
ChatGPT is becoming a friend that seems to know me! As it did last week, it became conversational and extended our dialogue with some thoughts of its own that seem more like conjecture than the mere spouting of fact. It continued:
An Interesting Observation
You have asked several questions over the past year about the relationship between medicine, public policy, and the common good. It is noteworthy that these physician-signers generally viewed medicine as a public trust, not simply a private profession. They routinely moved between caring for individual patients and addressing broader societal concerns—public health, education, sanitation, civic institutions, and governance.
That perspective is especially evident in Benjamin Rush. He believed physicians should help shape the moral and civic health of the nation, not merely treat disease. His vision anticipated many modern ideas about population health, the social determinants of health, and the physician’s role as a community leader.
Given your interest in healthcare reform and primary care, I think you would particularly enjoy Rush’s writings. Although some of his clinical treatments (such as bloodletting) are now obsolete, his ideas about physicians’ responsibilities to society remain remarkably relevant and continue to influence discussions about professionalism, public health, and medical ethics.
That seemed like a directive or at least a suggestion. So, I responded:
Can you suggest where to find Benjamin Rush’s writing or a good biography about his life and work?
I will spare you the lengthy answer, but as soon as I finish Regime Change: Inside the Imperial Presidency of Donald Trump by Maggie Haberman and Jonathan Swan, I will be diving into Rush: Revolution, Madness, and Benjamin Rush, the Visionary Doctor Who Became a Founding Father (2018). ChatGPT underlined its recommendation by saying:
The book presents Rush as a complex figure—brilliant, compassionate, sometimes wrong (particularly regarding bloodletting), yet remarkably visionary in his advocacy for education, abolition, mental health, and public health.
I think you’ll especially appreciate Fried’s treatment of Rush’s belief that medicine and democracy depend on one another.
The bot went one step further and recommended that I read Rush in his own words. The options include The Selected Writings, The Letters of Benjamin Rush, The Autobiography of Benjamin Rush, Medical Inquiries and Observations upon Diseases of the Mind (1812), An Inquiry into the Effects of Ardent Spirits upon the Human Body and Mind (1784), and Directions for Preserving the Health of Soldiers, a pamphlet he probably wrote while serving as Surgeon General of the Continental Army’s Middle Department.
Given today’s antivax enthusiasts, I wonder how many Americans appreciate the fact that many historians credit George Washington’s command that all of his soldiers be vaccinated against smallpox as a critical decision in America’s victory over the British. To confirm this impression, I asked ChatGPT:
How important to America’s victory over the British do historians view George Washington’s command that all of his soldiers be vaccinated against smallpox?
ChatGPT’s reply confirmed my impression:
Most military and medical historians regard George Washington’s decision to order the systematic inoculation (variolation) of the Continental Army in 1777 as one of the most consequential public health decisions in American history and one of the most important strategic decisions of the Revolutionary War. While historians are generally cautious about saying that any single decision “won the war,” many believe that the inoculation program significantly increased the likelihood of American victory.
I reasoned that, unlike our current leader, Washington had the presence of mind to consult the medical community before making such a critical decision that must surely have encountered some resistance. I wondered if the decision to vaccinate the troops was influenced by Benjamin Rush, so I asked:
Did Benjamin Rush advise Washington to have the Continental Army vaccinated against smallpox?
ChatGPT’s answer:
Yes. Benjamin Rush was one of several prominent physicians who strongly supported smallpox inoculation, and he advocated its use during the Revolutionary War. However, the historical record indicates that the decisive recommendation to inoculate the Continental Army came primarily from Dr. John Morgan, Dr. William Shippen Jr., Dr. Thomas Bond, and other military physicians who were directly responsible for the Army’s medical care. Rush was an important advocate for inoculation and later served as a physician in the Continental Army, but historians generally do not credit him alone with persuading George Washington to adopt the policy.
The story is nevertheless one of the most remarkable public health decisions in American history.
My question prompted ChatGPT to continue emphasizing how important this decision was in making it possible for us to celebrate our 250th birthday, and, sadly, how bereft of similar wisdom many in our current federal healthcare leadership are. Without another question, the bot continued to spew interesting information.
The Smallpox Threat
Smallpox was arguably a greater threat to the Continental Army than the British Army.
- Mortality often approached 20–30% among those infected.
- Survivors were frequently left blind or permanently scarred.
- British soldiers generally had greater immunity because many had already had smallpox or had been inoculated.
- Many American recruits, particularly from rural areas, had never been exposed and were highly susceptible.
Some historians estimate that smallpox caused more deaths than combat during parts of the Revolution.
Washington’s Initial Reluctance
George Washington understood both the danger of smallpox and the risks of inoculation (known then as variolation).
Variolation involved deliberately infecting a healthy person with material from a smallpox lesion. While it usually produced a milder illness and lifelong immunity, it was not without danger:
- About 1–2% of inoculated individuals died.
- Newly inoculated people could spread the disease.
- Temporarily disabling soldiers during wartime posed obvious military risks.
Initially, Washington prohibited widespread inoculation because he feared it could cripple the Army if an epidemic spread through the camps.
Benjamin Rush’s Role
Rush had studied medicine in Edinburgh, where inoculation was becoming accepted, and he was convinced of its value.
He:
- advocated inoculation before and during the Revolution,
- educated both physicians and the public,
- later cared for soldiers as a Continental Army physician,
- became one of America’s strongest supporters of preventive medicine.
His enthusiasm reflected his broader belief that physicians should protect the health of populations, not merely treat individual illnesses.
Washington Changes Course
By the winter of 1777, after repeated outbreaks, Washington concluded that failing to inoculate posed the greater risk.
On February 5, 1777, he ordered a systematic inoculation program for the Continental Army.
It was conducted in stages to:
- preserve military readiness,
- isolate recovering soldiers,
- prevent uncontrolled epidemics.
The program was carried out under strict secrecy so the British would not learn that large numbers of American troops were temporarily unfit for battle.
Why It Was So Important
Many historians consider this one of Washington’s greatest strategic decisions.
It:
- dramatically reduced deaths,
- improved troop readiness,
- increased morale,
- helped ensure the Continental Army remained an effective fighting force.
Some historians have argued that without this decision, the Revolution might have failed.
An Early Public Health Triumph
The campaign is often described as:
- one of America’s first national public health initiatives,
- an early example of evidence-informed military medicine,
- a precursor to modern vaccination campaigns.
Although Edward Jenner’s safer cowpox vaccination would not be introduced until 1796, Washington’s use of variolation represented one of the earliest large-scale preventive medical programs organized by a government.
A Modern Perspective
Given our many conversations about public health and preventive medicine, it’s striking how contemporary this episode feels. Washington and his physicians faced questions that still arise today:
- Should leaders act before all evidence is complete?
- How should policymakers balance individual risks against population benefits?
- How can public health measures be implemented while maintaining public trust?
- What role should physicians play in advising political leaders?
Benjamin Rush believed physicians had a duty to advise governments on matters affecting the public’s health—a view that anticipated today’s concept of physicians as advocates for public health.
One small historical clarification is worth noting: while Rush strongly supported inoculation, most historians attribute the recommendation for the Army-wide inoculation program to the collective advice of several physicians and to Washington’s own careful judgment. The decision was the product of collaboration between military leadership and medical experts, making it an early example of evidence-informed public policy.
So, as I watch the fireworks that my neighbors explode over our little lake, I have a new appreciation of the wisdom and influence of the brave physicians who risked everything, including their lives, by signing the Declaration of Independence. I am impressed that of the four MD signers, two were from my adopted home state of New Hampshire, and one, Matthew Thornton (for whom a medical practice and HMO, now part of Dartmouth Health, was named), was an immigrant who wasn’t present on the Fourth but signed it later. It occurs to me that since the announcement had already been made, he could have avoided the risk of a noose by letting it stand without his signature.
Finally, as so many conservative justices base their decisions on what they think the founding fathers were thinking, so-called originalism, interest in public health, and the health and welfare of everyone are ideas they should consider as they attempt to alter our times while justifying their decisions by co-opting and twisting some of the ideas of those founders. Our blessings exceed the common knowledge of the benefits that flow to us today because of the wisdom of our physician leaders in 1776. Have a very happy Fourth!
Be well,
Gene
That last statement resonated with me. I am convinced that medicine and democracy do depend on one another. It is inspiring to know that the relationship is not a new association. At least one of our founding fathers was aware of the interdependence. Rush is called the father of American Psychiatry and was totally aware of the importance of efforts to improve public health. Today’s antivaxers may not know that.
